Ureteral Injuries During Abdominal and Pelvic Surgery: T-Tube Splinting in Ureteroneocystostomy

1959 ◽  
Vol 81 (6) ◽  
pp. 728-736 ◽  
Author(s):  
Harold Lipshutz
Keyword(s):  
Pelvic Surgery ◽  
T Tube ◽  
Ureteral Injuries

scholarly journals Causes and prevention of Iatrogenic fistula during Gynaecologic Surgery

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Ashudeep Sharma
Keyword(s):  
Ureteral Injury ◽  
Pelvic Surgery ◽  
Minimal Risk ◽  
Predisposing Factor ◽  
Advanced Malignancy ◽  
Ureteral Injuries ◽  
Severity Of Injury ◽  
Bladder Injuries ◽  
Urologic Injury

Pelvic surgery is most common cause of iatrogenic ureteral injury. The incidence of ureteric range from 0.2 to 1% during various gynaecological procedure including laparoscopic surgery. The majority of ureteral injury has no identifiable predisposing factor and occurs more frequently for procedure forbenign lesion. Two third of injury are diagnosed postoperative period. When the injury is recognized intra-operatively, the lesion can be repaired immediately with minimal risk of long term sequelae.  Urological injuries to urinary bladder & ureter- uncommon but important. Surgical complications during various obstetric & gynecological open and laparoscopic procedures. One of the important factors is anatomic proximity of ureters & bladder to genital tract. Bladder injuries- most frequent urologic injury. Bladder injuries usually recognized and repaired immediately, and potential complications are typically minor. But ureteral injuries(70%) typically are not recognized immediately & can lead to long term complications. Risk factors are Enlarged uterus, Previous pelvic surgery or radiation, Advanced malignancy Endometriosis, PID ,Pelvic adhesions, distorted pelvic anatomy. Iatrogenic urologic injuries can be prevented by adequate pre-operative assessment, good surgical technique, and visualization of the bladder & ureters. Anticipation and high index of suspicion, early urological referral, and appropriate investigation of suspected urologic injury is of paramount importance. Post-operatively they may present with fever, flank pain and tenderness, oligouria, anuria, uremia, ileus, peritonitis, urinary leakage and hematuria depending upon severity of injury. To prevent ureteral injury surgeon must have thorough knowledge of anatomy and location of ureter during various gynaecological procedure and the specific sites where it is most susceptible to injury.

scholarly journals Iatrogenic Ureterovaginal Fistulae: Difficulties in Diagnosis and Treatment in Our Case series

2019 ◽  
pp. 01-06
Author(s):  
Cristina Palmer, DO ◽  
Bilal Farhan, MD ◽  
Gamal Ghoniem, MD FACS
Keyword(s):  
Case Series ◽  
Ureteral Injury ◽  
Pelvic Surgery ◽  
Fistula Formation ◽  
Gynecologic Surgery ◽  
Ureterovaginal Fistula ◽  
Vaginal Cuff ◽  
Ureterovesical Junction ◽  
Ureteral Injuries ◽  
Damage Risk

Ureteral injury is a known complication of pelvic surgeries, including gynecological, urologic, colorectal, and vascular surgeries. This can occur by transvaginal, laparoscopic, or transabdominal approach [1,2]. Gynecological surgery remains by far the most common means of injury (75%), followed by colorectal surgeries (14%) [3-5], with reports of ureteral injury during gynecologic surgery from 0.35% to 1.5% [4,6]. Total abdominal and laparoscopic hysterectomies are the most common procedures where ureteral injury occurs [1,5]. Injury occurs most often at the level where the ureter courses under the uterine vessels, followed by the ureterovesical junction and the base of the infundibulopelvic ligament [4,7,8]. Many ureteral injuries occur during uncomplicated, routine surgery [8,9]. An abnormal connection between the ureter and vagina, or ureterovaginal fistula, allows for a conduit through which urine can continually leak. This is specific to the combination of ureteral injury and hysterectomy where the urine finds its way to the freshly closed vaginal cuff. Genitourinary fistula formation remains one of the most feared complications of pelvic surgery, with lasting emotional damage, risk for infections, infertility, reoperation, and increased hospital stay [5,10]. Our objective is to present the difficulties encountered in management of our cases and how to rectify them.

Ureteral injuries in pelvic surgery

1957 ◽  
Vol 94 (3) ◽  
pp. 421-430 ◽  
Author(s):  
Harry R. Newman ◽  
Robert Hotchkiss ◽  
Sidney Gordon
Keyword(s):  
Pelvic Surgery ◽  
Ureteral Injuries

Ureteral Injuries in Routine Pelvic Surgery

1959 ◽  
Vol 43 (6) ◽  
pp. 1713-1729 ◽  
Author(s):  
B. Marvin Harvard
Keyword(s):  
Pelvic Surgery ◽  
Ureteral Injuries

Analysis of efficiency of application of media with hyaluronic acid in cryoprotocols

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. 26-29
Author(s):  
Natalia V. Protopopova ◽  
Elena B. Druzhinina ◽  
Kseniia V. Krylova ◽  
Iuliia V. Mylnikova ◽  
Jan A. Dvoryanov ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Culture Medium ◽  
Genetic Diagnosis ◽  
World Health ◽  
Practical Significance ◽  
Pelvic Surgery ◽  
High Concentration ◽  
Tubal Infertility

According to the World Health Organization, about 2 million new couples experience infertility annually, and their number is growing. An effective way to overcome infertility is assisted reproductive technology (ART). Cryopreservation will rationally solve the issue of preservation and further use of embryos: to delay pregnancy for some time considering womans desire and to prevent ovarian hyperstimulation syndrome. Embryo freezing allows to reduce the rate of repeated ovarian stimulation and perform preimplantation genetic diagnosis. Over the past decades, various cryotransfer options have been proposed to increase ART treatment efficacy, including the use of a culture medium with a high concentration of hyaluronic acid, but there are conflicting data on the use of such a medium in ART programs. Aim. Evaluation of thawed embryo transfers efficacy using the hyaluronic acid-containing culture medium. To achieve the goal, the following tasks were set: to evaluate clinical and medical history data of patients with tubal infertility in cryoprotocols, to analyze the previous cycle of in vitro fertilization and embryological stage, to evaluate the effectiveness of the culture medium with a high content of hyaluronic acid. Materials and methods. A detailed description of the patient sample, inclusion and exclusion criteria, embryological stage, embryo grading, devitrified embryo transfer technique. The article includes 3 tables which present the groups general clinical characteristics, the embryological stage, the rate of pregnancy, depending on the cultivation day. Results. The authors established that in patients with a history of pelvic surgery and sexually transmitted infections, it is advisable to use the culture medium with a high content of hyaluronic acid to transfer the thawed embryo. It was shown that pregnancy rate is 1.5 times higher when transferring devitrified embryos on the 5th day of development with the use of hyaluronic acid-containing culture medium. The conclusion about the pregnancy rate in obese patients is not indisputable, which requires further study. The authors also provide practical recommendations on the use of the culture medium with hyaluronic acid in cryoprotocols. Conclusion. The study allows to optimize the devitrified embryo transfer in patients with tubal infertility using a culture medium with a high content of hyaluronan. This work has undoubted scientific and practical significance.

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